21 and Counting

Just as quickly as it arrived, Ebola has left the front page. The bulk of the Dallas Hospital healthcare workers as well as those who had community contact with Thomas Eric Duncan have cleared the 21 day isolation period and are free to move around. It seems clearer now that the two infected nurses got Ebola through lapses in the protocol used to protect them. Success, a triumph for medical knowledge and common sense.

Of course there could be more healthcare workers infected from new cases just as it is possible for Ebola could be transmitted from exposed or infected overseas travelers. But other than a complete and total quarantine of the US (no boats, planes or vehicular traffic) there can be no 100% precaution that Ebola could not again enter the US.

The anti diminishing returns argument that the US needs to screen and detain all African travelers entering the US will still be made. These advocates are in fact in search of different objectives than healthcare. We need to drown out these “sky is falling” voices.

There is a far larger issue hidden in plain sight with this Ebola outbreak. What about a real pandemic, like SARS or bird flu or any other contagion? What if Iran or al Qaeda or whomever decided to use health as the means to attain their goals?
We have been there once with germ warfare. Fortunately, the world did not employ these agents but these are different times. Beheading someone and showing it proudly on the internet does not seem to me far away from turning a biological agent loose in London or New York.

The limited experience in Dallas ought to inform everyone that hospitals that are set up to make money treating common illnesses and injuries will most likely not have prioritized how to handle contagions very high in their sights. Protocols will be suspect as will be the necessary protective equipment.

The spin doctors, however, can create the necessary PR to keep an outbreak appear under control. The actual health care safety net has too many holes if we judge Dallas’ response.

There is certainly a limit to what medical science can do. There are no cures for some diseases. The question is what should the healthcare industry and government health officials do to contain any outbreak until the disease runs its course with minimum impact on the general population?